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What the city can do to improve our health

Easy access to grocery stores and walkable neighbourhoods play a significant role in the health of Torontonians.

An idea gaining favour in major cities is “complete streets,” a city-planning concept that promotes development of streets for all citizens, whether they are pedestrians, cyclists, drivers or transit users. Here, cyclists and pedestrians enjoy the busy streets of Toronto's Kensington Market. (Darren Calabrese / THE CANADIAN PRESS)

By Danyaal RazaEdward Xie

Sat., July 19, 2014

Where you live in a city defines how healthy you are. Often, we think of health in terms of hospitals and clinics: matters for the province to look after. Yet, the environment in which we live, work and play has an enormous impact on our health.

No level of government has as much power to directly shape these factors as the city. Health is a city hall issue and in no area is this more obvious than chronic diseases like heart disease, diabetes and osteoporosis.

In the case of diabetes, almost one in 10 adults in Toronto is afflicted with the condition. Diabetes is incurable but it is preventable, which is why the Toronto city council and mayoral election on Oct. 27 is so important to your health.

As doctors who operate on the opposite ends of the care spectrum, we work on all aspects of diabetes care. One of us is a family doctor, counselling on prevention and management of diabetes and other chronic health issues, while the other works in the ER dealing with their dire consequences. We both recognize that our ability to prevent, to heal and to rescue only play a small role in the health of our patients.

Doctors often recommend the “exercise and diet” strategy to prevent and treat diabetes and other ailments. We should apply the same action plan to build and govern our cities.

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Already, diabetes inflicts an oppressive toll on the health of Torontonians. The statistics are revealed with stark detail in the Toronto Diabetes Atlas. Diabetes is concentrated in the inner suburbs of Etobicoke and Scarborough: rates are almost double those of “Old Toronto” neighbourhoods. Humber Summit has a diabetes rate of 7.6 per cent, while Yonge-St. Clair sits at 3 per cent. Diabetes Atlas authors found a “strong and consistent association” between high rates of diabetes and areas lacking walkable streets and cycling lanes. To underscore the problem, bicycle and walking trips were also the fewest in areas where diabetes was rampant.

What if city council took our health into account when designing neighbourhoods? An idea gaining favour in major cities around the world is “complete streets,” a city-planning concept that promotes development of streets usable by all citizens, whether they are pedestrians, cyclists, drivers or transit users. As things stand now, getting to schools, parks and stores without a car is only a dream for residents without the lush tree cover, dense transit networks and regularly spaced traffic crossings of downtown.

The science is clear: people are more likely to walk to a store if it can be reached within five to 10 minutes, while those who spent more time travelling by car had a greater likelihood of being obese. All it takes, according to a new international study, is an extra 2,000 steps a day — about 20 minutes of walking — to reduce heart attacks and strokes by 8 per cent in people at risk for diabetes. It should be no surprise, then, that building walkable neighbourhoods can discourage sprawl and prevent diabetes and its complications.

Diet is the other front in the fight against diabetes. What does that look like for the city as a whole? Toronto’s neighbourhoods with the highest diabetes burden have remarkably poor access to fresh, wholesome food in easy-to-reach grocery stores. The problem is most acute again in the inner suburbs: Scarborough, North York and Etobicoke. These are neighbourhoods where buying fresh vegetables can be more challenging than ordering French fries. American researchers have found that for each additional supermarket gained in a census tract, fruit and vegetable intake increased by 32 per cent for African-Americans and 11 per cent for Caucasians.

Some innovative solutions already exist; in fact, Toronto has been a Canadian leader by creating the Toronto Food Policy Council in 1990 and adopting the bold Toronto Food Charter in 2001. The city already supports the FoodShare organization to bring grocery stands, school meals and inexpensive fresh food via mobile markets to residents who need them.

Still more can be done. A prosperous city is nourished by healthy, productive citizens. We need visionary city planning to remedy these problems with rational zoning, support for community initiatives and a city council that takes health seriously.

These issues matter more now than ever before. Toronto is in the midst of a historic mayoral race attracting worldwide attention. The health of our city and its citizens deserves more attention. Our mayoral and city council candidates need to hear that your health matters when they come asking for your vote.

Danyaal Raza is a community family physician and serves on the Ontario College of Family Physicians’ Poverty &amp; Health Committee. Edward Xie is an emergency physician and lecturer at the University of Toronto.

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